Introduction: Acute lumbar disc herniation (LDH) is one of the leading causes of back pain and radicular symptoms. Initial treatment is often conservative; however, a proportion of these patients will improve, owing to the natural inflammatory response of the body, whereby disc resorption and potential relief of symptoms may occur. However, commonly-prescribed oral steroids and other anti-inflammatory agents may disrupt the natural macrophage-driven disc resorption, potentially increasing the duration of symptoms. The concept of an “inflammation-preserving” treatment for LDH in humans has yet to be explored. As such, the following is a one-year prospective study to assess the clinical outcomes and rate of disc resorption in acute LDH patients undergoing inflammation-preserving treatment (i.e. no NSAIDs, steroids).
Methods: All patients received Gabapentin to relieve leg pain, 12 sessions of acupuncture. Repeat MRI was performed, every 3 months, after 12 sessions of treatment continued for those without 40% reduction in herniated disc sagittal area. The size of disc herniations were measured on sagittal T2W MRI sequences, pre-treatment and at post-treatment intervals. Patients were further stratified to fast, medium, slow and prolonged recovery groups in relation to symptom resolution and disc resorption.
Results: 90 patients (51% females; mean age: 48.6 years) were assessed. Mean size of disc herniation was 119.54 ± 54.34 mm2 and the mean VAS-leg score was 6.12 ± 1.13 at initial presentation. A total of 19 patients (21.1%) improved at the time of the repeat MRI (i.e. within first 3 months post-treatment). 100% of all patient had LDH resorption within one year (mean: 4.4. months). There was no significant difference in baseline LDH between fast, medium, slow, and prolonged resorption groups. Initial LDH size was weakly associated the degree of leg pain at baseline and initial gabapentin levels. Surgery was avoided in all cases.
Discussion: This is the “first” study to note inflammation-preserving treatment utilizing Gabapentin and acupuncture, without conventional anti-inflammatory medications, as safe and effective for patients with an acute LDH. The rate of disc resorption (100%) was higher than comparative recent meta-analysis findings (66.7%) and no patient underwent surgery. Future comparative studies are needed for replication and to assess further. However, the present study raises awareness of a potential novel therapeutic modality that would allow for natural resorption of the LDH with sustained pain relief while also avoiding the pitfalls and side-effect profiles associated with anti-inflammatory medication.